{"id":2523,"title":"PROPOSAL FORM FOR All Risk Policy","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/commercial-insurance/all-risk-policy/All-Risk-Policy-pf.pdf","sha256":"4229786eefdcedeea78758b1294cbe6fda2e0493f697b87bf46d64a2387b5d62","pages":6,"collected":"2026-10-17","instructions":{"about":"This form is used by individuals or entities proposing to insure portable equipment against loss or damage under the All Risk Policy. The proposer fills this form to provide details about themselves, the property to be insured, and other relevant information for underwriting.","notes":["Answer every question fully.","Ensure that the property is correctly described and insured for full value to get adequate indemnity.","Use block letters for name.","Attach invoice copy if item recently purchased.","Attach Disability Certificate if applicable.","Keep policy contact details updated for faster service.","The form includes a prohibition of rebates as per Section 41 of Insurance Act, 1938.","The agent/intermediary must explain the form contents to the proposer in vernacular if required."],"title":"PROPOSAL FORM FOR All Risk Policy","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"Write your full name in block letters","type":"text","label":"a. Name of person (in full) (in BLOCK LETTER)","options":[],"required":true,"pdf_field":""},{"help":"Write your full residential address","type":"text","label":"b. Residential Address","options":[],"required":true,"pdf_field":""},{"help":"Provide your occupation or profession and its address","type":"text","label":"c. Occupation/Profession and address","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Property to be Insured","fields":[{"help":"Serial number of the property item","type":"number","label":"Sr. No.","options":[],"required":true,"pdf_field":""},{"help":"Provide bank details for claim payment","type":"text","label":"Bank Details","options":[],"required":false,"pdf_field":""},{"help":"Name as per bank records","type":"text","label":"Name as pr Bank","options":[],"required":false,"pdf_field":""},{"help":"Name of your bank","type":"text","label":"Name Of Bank","options":[],"required":false,"pdf_field":""},{"help":"Your bank account number","type":"text","label":"Bank Account No.","options":[],"required":false,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSCCode","options":[],"required":false,"pdf_field":""},{"help":"Describe the property fully and accurately","type":"text","label":"Full Description of Property","options":[],"required":true,"pdf_field":""},{"help":"Tick to confirm acceptance","type":"checkbox","label":"* I accept to pay & receive claim amount (if any) in the above given Bank a/c","options":["accept"],"required":true,"pdf_field":""},{"help":"Provide e-lA number if available","type":"text","label":"Electronic-Insurance Account: Please provide e-lA No. to deposite your insurance policy.","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Do you want to open e-lA account:","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Are you an exisiting customer of BGIL","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide PID or Policy number if existing customer","type":"text","label":"If Yes. Please provide PID No: /Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Tick to confirm no change in KYC details","type":"checkbox","label":"I hereby confirm that, there is no change in my existing KYC details that are available from my previous/existing policy.","options":["confirm"],"required":false,"pdf_field":""},{"help":"Enter sum insured amount in rupees","type":"amount","label":"Sum Insured Rs","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Constitution Details","fields":[{"help":"Specify constitution if applicable","type":"text","label":"If Yes Specify Constitution","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Partnership Firm","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Limited Liability/Partnership Firm","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"NGO/NPO- Provide DARPAN Portal Registration, if applicable","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Company","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Trust","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Society","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Section 8 Company","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Proprietorship Firm","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify other constitution if applicable","type":"text","label":"Others (Please specify)","options":[],"required":false,"pdf_field":""},{"help":"Provide DARPAN portal registration details if applicable","type":"text","label":"DARPAN DETAILS","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Additional Information","fields":[{"help":"Select Yes or No and attach invoice if Yes","type":"yes-no","label":"Has the item been recently purchased? and if so, furnish the Invoice copy.","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details if cover outside India is required","type":"text","label":"Whether cover is also required outside India. if yes give details","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Is the risk currently insured against Fire.","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Name of fire insurance company if insured","type":"text","label":"a. The name of the Company","options":[],"required":false,"pdf_field":""},{"help":"Fire insurance policy number","type":"text","label":"b. Policy No.","options":[],"required":false,"pdf_field":""},{"help":"Period of fire insurance coverage","type":"text","label":"c. Period","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Have you suffered any loss of or damage to these items in the past? (Irrespective of whether insured or not)","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details of past loss or damage","type":"text","label":"If so, give full details thereof as under:","options":[],"required":false,"pdf_field":""},{"help":"Date when loss/damage occurred","type":"date","label":"Date of Occurrence","options":[],"required":false,"pdf_field":""},{"help":"Describe the loss or damage","type":"text","label":"Details of loss","options":[],"required":false,"pdf_field":""},{"help":"Amount of loss in rupees","type":"amount","label":"Amount of loss Rs.","options":[],"required":false,"pdf_field":""},{"help":"Name of insurance company for past loss","type":"text","label":"Name of the Insurance","options":[],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"Has any company in respect of Insurance a. Declined your Proposal?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"b. Cancelled or refused to renew your policy?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"c. Accepted your proposal on special terms and conditions?","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Specify insurance periods","type":"text","label":"Periods or Insurance","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Payment Details","fields":[{"help":"Select mode of payment","type":"choice","label":"Mode of Payment:","options":["Cheque","DD","Cash","Other"],"required":true,"pdf_field":""},{"help":"Select who gave the cheque if applicable","type":"choice","label":"Cheque - Given by:","options":["Spouse","Father","Mother","Son/Daughter","Employer / Employee","Financier"],"required":false,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declaration by Proposer","fields":[{"help":"Sign to declare that all information is true and complete","type":"signature","label":"Declaration","options":[],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations and Consents","fields":[{"help":"Select Yes or No","type":"choice","label":"Are you or any of the proposal applicants a PEP or a close relative of PEP?","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through Central KYC Registry or other portals","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"I/we hereby declare and confirm that the premium has been paid out of legally acquired sources of income","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"I/We hereby give voluntary consent to Company to share my/our personal information and data provided in this proposal form with its group companies or any other person","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Select Yes or No","type":"yes-no","label":"It is mandatory to keep your policy with updated contact (Mobile No., Email ID and PAN Card) and bank account details","options":["Yes","No"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Physical Disability Declaration","fields":[{"help":"Select Yes or No","type":"choice","label":"Any Physical deformity or handicap","options":["Yes","No"],"required":false,"pdf_field":""},{"help":"Provide details and attach Disability Certificate issued by Government Medical Board","type":"text","label":"If Yes. Please provide details:","options":[],"required":false,"pdf_field":""},{"help":"Name of authorised representative if proposer has disability","type":"text","label":"Name of Authorised Representative","options":[],"required":false,"pdf_field":""},{"help":"Signature of authorised representative","type":"signature","label":"Signature of Authorised representative","options":[],"required":false,"pdf_field":""},{"help":"Date of signature","type":"date","label":"Date","options":[],"required":false,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":false,"pdf_field":""}],"filled_by":"proposer or authorised representative"},{"title":"Claim Documents Confirmation","fields":[{"help":"Confirm that all required documents for policy issuance are provided","type":"checkbox","label":"Claim Docs","options":["I/we hereby confirm that I/we have provided all relevant and supporting documents sought by the company"],"required":true,"pdf_field":""}],"filled_by":"proposer"},{"title":"Agent/Intermediary Declaration","fields":[{"help":"Provide agent license number","type":"text","label":"IRDAI COR No./ License No.(Advisor/Corporate Agent/Broker/Relationship Officer)","options":[],"required":true,"pdf_field":""},{"help":"Agent's signature","type":"signature","label":"Signature of Agent","options":[],"required":true,"pdf_field":""},{"help":"Date of signing","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Place of signing","type":"text","label":"Place","options":[],"required":true,"pdf_field":""},{"help":"Agent or intermediary signature and code","type":"text","label":"Agent / IMD (SP/DP/ BQP) signature and their code","options":[],"required":true,"pdf_field":""},{"help":"Agent or IMO name","type":"text","label":"Agent/IMO Name","options":[],"required":true,"pdf_field":""},{"help":"Agent or IMO code","type":"text","label":"Agent/IMO Code","options":[],"required":true,"pdf_field":""},{"help":"Name of SP/BQP/DP/PoS","type":"text","label":"SP/ BQP /DP/ PoS Name","options":[],"required":true,"pdf_field":""},{"help":"Code of SP/BQP/DP/PoS","type":"text","label":"SP/ BQP /DP/ PoS CoR No.","options":[],"required":true,"pdf_field":""},{"help":"Signature of SP/BQP/DP/PoS","type":"signature","label":"SP/ BQP /DP/ PoS Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"agent"}],"deadlines":[],"applies_to":"All Risk Policy covering portable equipment as per the policy schedule","attachments":["Invoice copy if item recently purchased","Disability Certificate issued by the Medical Board appointed by the Government for certifying Disability"],"declarations":["The proposer declares that all statements and answers are true and complete and form the basis of the contract.","The proposer agrees to take reasonable precautions for the safety of the property as if uninsured.","The proposer consents to the company sharing information within group entities.","The proposer confirms premium is paid from legally acquired sources and future premiums will be similarly paid.","The proposer consents to sharing personal information with group companies for products and services.","The proposer confirms keeping policy contact and bank details updated for faster service.","The proposer confirms understanding the form content and particulars as explained in vernacular.","The agent declares having explained the form contents and consequences of untrue statements or non-disclosure."],"dropped_labels":2},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"email","value":"careforyou@bajajgeneral.com","label":"Customer Service Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/forms/form-online-grievance.html","quote":"in a new tab\nBajaj General Insurance Limited\nTollfree: For sales :\n1800-209-0144\nFor service :\n1800-209-5858\nEmail id:\ncareforyou@bajajgeneral.com\nFor senior citizens:\nseniorcitizen@bajajgeneral.com\nFor senior citizens:\n1800-209-5858\nFax no:\n020-30512246\nRegistered","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-209-5858","label":"Service Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/forms/form-online-grievance.html","quote":"Careers\nBecome\n                                An Agent\nAwards\nUpdate KYC\nMY ABHA\nBuy Policy:\n1800-209-0144\n| Service:\n1800-209-5858\nService Chat:\n+91 75074 25858\nInsure\nHealth Insurance\nIndividual Health Insurance\nFamily Health Insurance\nInternational","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-209-0144","label":"Sales Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/forms/form-online-grievance.html","quote":"nsurance\nSupport\nAbout Us\nCareers\nBecome\n                                An Agent\nAwards\nUpdate KYC\nMY ABHA\nBuy Policy:\n1800-209-0144\n| Service:\n1800-209-5858\nService Chat:\n+91 75074 25858\nInsure\nHealth Insurance\nIndividual Health Insurance\nFamily Healt","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-209-5858","label":"Customer Service Toll Free Number","level":1,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"ted servicing team to help you meet your service needs.\nCustomer Service - We're Here to Help\nDial our Toll Free Number\n1800-209-5858\nEmail us on\ncareforyou@bajajgeneral.com\nToll free No. Intermediary\n1800-209-7073\nBOING BOT\nConnect with us on BOING Cha","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"ggro@bajajgeneral.com","label":"Grievance Redressal Officer Email Mr. Jerome Vincent","level":2,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"fied with the response given to you by our team, you may write to our Grievance Redressal Officer Mr. Jerome Vincent at\nggro@bajajgeneral.com\nLevel 3\nHead Customer Service\nif you are still not satisfied with the solutions provided, or have some feedback for us,","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-209-7073","label":"Toll free No. Intermediary","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"Here to Help\nDial our Toll Free Number\n1800-209-5858\nEmail us on\ncareforyou@bajajgeneral.com\nToll free No. Intermediary\n1800-209-7073\nBOING BOT\nConnect with us on BOING Chatbot\nConnect with us on WhatsApp +91 7507425858\nFor Support\nBajaj General App\nPle","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"whatsapp","value":"+91 7507425858","label":"BOING WhatsApp Chatbot","level":null,"hours":"24x7","applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"ral.com\nToll free No. Intermediary\n1800-209-7073\nBOING BOT\nConnect with us on BOING Chatbot\nConnect with us on WhatsApp +91 7507425858\nFor Support\nBajaj General App\nPlease scan and download\nMissed Call Facility\nMissed Call - 80809 45060 Short code - SMS","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/bajaj-general-insurance/2523-proposal-form-for-all-risk-policy"}